Ready or not, health care providers and their patients across the country had to quickly embrace telemedicine visits when the coronavirus disease 2019 (COVID-19) pandemic made in-person visits risky, especially for older patients who are most at risk for complications from the disease.
We spoke with a patient after he had his first telemedicine visit with his pain specialist, to get his take on the experience.
James F. Fuhlman, MS, RPH, a retired hospital pharmacist who lives in Yakima, Washington, regularly sees a pain specialist for back pain stemming from a serious motor vehicle crash in his youth. In the interest of transparency, we disclose that he is also the father of a Topics in Pain Management editorial staff member.
When approached about giving his perspective as a telemedicine patient, Fuhlman graciously agreed. As the Northwest United States was where the first US cases were recorded, his region was among the first to feel the impact. By May, he had already had 3 telemedicine visits with 3 different physicians: a pain specialist, an internist, and a urologist. All were on the Zoom platform, which he accessed via his MacBook Air.
"I'm a pretty low-maintenance patient," Fuhlman said. "It might have been very different if I were having more trouble. I don't take any opiates. I put a lot of effort into staying active. Before the pandemic, I was going to the YMCA every week day to exercise for an hour and then playing racquetball for 1 to 2 hours with friends. In addition, I walk after dinner every night for 1 to 2 miles."
Fuhlman is very active, so the travel and waiting time spent on an office visit is something he is happy to let go of if it is not necessary. He said he hopes telemedicine visits can be an option even beyond the pandemic.
"But I'm sure there will be times when I will really want my doctor to be able to see me and look at my spine. Some of that nonverbal part of the visit that might escape you if you were in a telemedicine visit," he said.
Certain Visits Ideal for Telemedicine
Fuhlman has had a Medtronic infusion pump for several years. He usually sees his pain specialist every 3 months for a check-up, and then a week or so later to have his pump reservoir refilled. It usually required 2 different visits on 2 different days - 1 day for the physician visit, then the medication would be ordered, and he would have to then go to the hospital infusion center for the reservoir to be refilled.
"I do prefer [telemedicine visits] for something like that," he said. "If I don't have to go in, I'd rather not."
With the telemedicine visit, he had to only make one actual trip-for refilling the reservoir.
His pump is due to be replaced, and at the time of this interview, he had a tentative date scheduled for the summer for this surgery. It had already been postponed because the hospital was doing so with all elective procedures during the worst of the pandemic.
Limits of the Televisit
A lot of pain medicine practice hinges on the practitioner's ability to observe movement or to touch the patient to determine the source and type of pain, and other approaches that simply cannot be done over a Zoom visit.
Fuhlman said he had the sense that he was one of his doctor's first televisits, and that there were some delays and frustration on the doctor's part with what he could not do, and in learning the televisit technology and practices.
In fact, the qualities and diligence that make Fuhlman's pain physician such a good doctor seemed to be the source of the most frustration-but more so for the doctor than for the patient, in this case.
"He's a very hands-on kind of doctor, which I like, so he had to rely on my telling him how I was feeling. Normally, he will have me turn around and he'll watch the way I walk," Fuhlman said of his typical in-person visits. "Normally he's very punctual, but the appointment started almost an hour late."
The Telemedicine Proficiency Learning Curve
Shortly after that pain physician visit, Fuhlman had televisits with his internist and his urologist. Both went well, and like his pain visit, did not involve any need to remove clothing, which Fuhlman acknowledged would feel very weird for a televisit.
Fuhlman could not help but notice among his 3 physicians a range of comfort and proficiency with the technology of telemedicine and with the remote nature of it.
One just seemed "out of his element," but only because he is such a thorough and observant physician who asks a lot of questions and pays attention to the answers, and really takes time with his patient.
"He looks at everything, and sometimes with pain, you have to really pull a lot of information out of the patient. I'm one of those people," he said. "I'm not going to unload on the provider every time I go in." So he appreciates that his physician goes a bit deeper with his questions.
Two of the physicians were more comfortable with televisits, and it seemed to correlate with their respective proficiency with technology in general. In some cases, it was simply a matter of communication among him, the nurse, and the physician about what was to be done beforehand.
"[The internist] was upset that I had not weighed myself and taken my blood pressure before the visit started. I had asked the nurse if I should do that, and she had said no, but the doctor said yes." So now, Fuhlman plans to do that before any future televisits.
He also had an annual examination televisit with his urologist, for which Fuhlman had gone to the laboratory for blood work beforehand.
At 76, he said, "That's part of our life-dealing with physicians."
It can be time-consuming with all of the downtime and waiting, and traveling to and from the office or hospital infusion center. So if there are ways to reduce some of those visits to telemedicine, that is about 2 to 3 hours of his time that can be devoted to other things, like hiking or going on a trip to the beach with his wife in their recreational vehicle.
Postpandemic: Will Telemedicine Be the Norm?
Fuhlman imagines that, postpandemic, patients might be given the option of a televisit when appropriate, and he believes many will opt for it.
"I would prefer to do some visits over telemedicine," Fuhlman said. "Sometimes, when I'd go in, they could be an hour-and-a-half behind schedule. I understand it, because of the patients, and because they're good clinicians they spend a little more than the allotted time with each patient. But you're also in the waiting room sometimes with people coughing and hacking."
Some patients might wonder, "Am I getting my money's worth," he said, but he looks at the cost of time and effort from getting to and from the office.
"Particularly for seniors, who are a lot of the people who go to the doctor, there's the issue of getting to and from the office, and then sitting for an hour in the waiting room, for a 5-minute visit with the doctor," Fuhlman said. He allowed that seniors are sometimes not the most technology-savvy members of the population, but many of them are now accustomed to using platforms such as Zoom to interact with their grandchildren and with each other during the pandemic.
With telemedicine offered as an option, he said, "Some of this could be so much easier for them."